PROJECT SUMMARY/ABSTRACT
Many emerging adults (aged 18-25) in the U.S. are living with unrecognized and/or untreated depression and
anxiety. Emerging adults have the highest rates (26%) of mental illness (MI) and lowest rates of treatment
seeking (38%), compared to all other age groups. Untreated depression and anxiety are particularly prevalent
among emerging adults and are key risk factors for the development of substance use disorders, cardiovascular
disease, and chronic health conditions later in adulthood, as well as premature death. Efficacious MI treatments
are available, but MI stigma is a substantial barrier to recognizing and treating depression and anxiety. Emerging
adults are particularly vulnerable to MI stigma given intense cognitive, biological, and social changes occurring
during these years. Although scientists have begun to assemble and refine an evidence-based stigma-reduction
toolbox, stigma interventions have fallen short of fully addressing MI stigma in part because they take a “one
size fits all” approach. Stigma interventions may be more efficacious if they address stigma mechanisms when
they are most pronounced, target the specific stigma mechanism(s) that are most harmful to treatment outcomes,
and provide extra support for people who lack resilience to stigma. Our long-term goal is to tailor MI stigma
interventions for emerging adults to promote positive treatment outcomes and lifetime wellbeing. In order to
inform the tailoring of these interventions, we need greater understanding of how stigma evolves and impacts
treatment outcomes during emerging adulthood. The objective of the current proposal is to examine longitudinal
relationships between MI stigma and treatment outcomes among a large, national sample of emerging adults.
Our specific aims are to: (1) Characterize trajectories of MI stigma mechanisms and identify moderators of
trajectories among emerging adults experiencing depression and/or anxiety; (2) Examine associations between
MI stigma mechanisms, MI recognition and MI treatment engagement over time; and (3) Identify latent profiles
of MI stigma mechanisms, how individuals transition across profiles over time, and links between profiles and
treatment engagement. We propose a national, longitudinal study of emerging adults (aged 18-25), surveying
4000 participants 4 times a year for 3 years regarding stigma mechanisms, moderating factors, mental health,
and treatment engagement. Based on epidemiological estimates, we project that ~30% (n=1200) of participants
will experience a new onset of depression or anxiety during the study. Data will be analyzed using multilevel
modeling, moderation analyses, latent profile and latent transition analyses. Findings will enable researchers to
better identify: (1) the ideal timing of stigma interventions to maximize impact among emerging adults, (2) who
among emerging adults are most vulnerable to the effects of stigma, (3) which stigma mechanisms should be
targeted for intervention to improve lifelong health and wellbeing, and (4) how to combine stigma-reduction tools
for subgroups of emerging adults. This proposal responds to NIMH and NICHD’s strategic objectives to
determine when, where, and how to intervene to improve healthcare during the transition to adulthood.
